While the healthcare industry continues to debate whether or not the benefits of implementing an Electronic Medical Records (EMR) system justify the cost, a community in southeast Wisconsin is proving there’s value not just to digitizing patient data but to sharing it across organizational boundaries.
The Wisconsin Health Information Exchange (WHIE)
“Emergency Department (ED) Linking Project” uses Microsoft Amalga, a comprehensive health intelligence system, to support health data exchange across more than 40 hospitals in southeast Wisconsin for multiple purposes. The ED Linking Project was implemented across Milwaukee County to improve care coordination, reduce the number of unnecessary procedures and redundant testing, and significantly reduce costs—which translates into higher quality care and health plan savings that can be passed along to patients.
According to a study conducted by WHIE and Humana Inc. from December 2008 through March 2010, and published in the July/August issue of American Health & Drug Benefits
, ED clinician use of the WHIE resulted in an average savings of $29 per emergency department visit. These savings primarily reflect a decrease in four of the top five ED-based procedures performed: CT scans, EKGs, laboratory testing and diagnostic radiology. Redundant testing represents a huge strain on the healthcare system, and as the study demonstrates, can be reduced when ED clinicians have the right information at their fingertips. This degree of savings, if extrapolated across all of the emergency encounters in the country (120 million per year), could potentially yield $3.5 billion in savings annually.
As an emergency physician in the Milwaukee area for 20 years prior to joining Microsoft, I witnessed the types of problems that can occur when regional exchange of health information does not occur. In 2007, local health care providers, public health leaders, and the State of Wisconsin Medicaid program launched a large-scale project to start a regional health information exchange.
From the beginning, WHIE leaders recognized that the exchange needed to utilize an architecture that improved care of individual patients, and also provided data to support initiatives to improve care across populations. As a result of this thinking, and in contrast to many other exchange efforts that concentrate only on point to point messaging, WHIE implemented Amalga to support a regional data aggregation strategy as a core component of the solution. The Amalga architecture, coupled with a comprehensive policy framework, means participating providers do not lose control of their data when they share a copy of the exchange. Instead they have confidence that their data will be secure and will only be released based on rules that they have approved in advance.
The WHIE ED Linking Project was designed to improve the quality, safety and cost-effectiveness of care through a secure, rapid-response HIE system. It was designed to be used not only by ED clinicians, but also by social workers and case managers to improve care coordination, and by public health officials to support population health initiatives. The project was initially funded in part by a Medicaid Transformation Grant and additional investments were made by the five major Milwaukee area healthcare provider systems. The Wisconsin Department of Health Services (DHS) and Milwaukee Health Care Partnership are other key partners to the WHIE.
The WHIE currently uses Amalga to aggregate patient data from state Medicaid claims, 44 hospitals, more than 120 associated hospital service areas and physician clinics, one Federally Qualified Health Center and a Medicaid managed care organization (MCO).
By pulling together data from a wide range of IT systems, the WHIE allows emergency physicians at 10 hospitals in Milwaukee County to automatically receive, at the time and point of care, a patient’s medical summary. The ED physician can see filled prescription data, allergies, current and previous chief complaints and diagnoses—information that is typically unavailable as patients enter the Emergency Department and yet critical to making fast and informed decisions about treatment.
The success of the WHIE prompted Humana, one of the largest health benefits companies, to support WHIE financially and incent providers to use the WHIE during encounters. And as the study shows, Humana has realized economic value from the arrangement, prompting Humana to suggest that the cost-savings might increasingly be used to invest in funding and sustaining HIEs.
This is the first time a health plan organization has attested with supporting data in peer reviewed literature that this type of business strategy makes sense. Hopefully, the results discussed in the publication will lead to additional studies contributing to the growing body of evidence around the positive benefits resulting from regional aggregation of data and effective use of health information exchange.